Document Type : Review Article

Authors

1 KIT Royal Tropical Institute, Amsterdam, The Netherlands

2 Faculty of health, WHO collaborating centre, University of Technology, Sydney, NSW, Australia

3 Athena Institute for Research on Innovation and communication in Health and Life Sciences, VU University, Amsterdam, The Netherlands

4 World Bank, Washington, DC, USA

Abstract

Background 
Conflict has devastating effects on health systems, especially on health care workers (HCWs) working in under-resourced and hostile environments. However, little evidence is available on how policymakers, often together with development partners, can optimize the organization of the health workforce and support HCWs to deliver accessible and trustworthy health services in conflict-affected settings (CAS).

Methods 
A scoping review was conducted to review the recent evidence (2016-2021) on human resources for health (HRH) in CAS, and critically discuss HRH challenges in these settings. Twenty-four studies were included in the review and results were presented using an adapted version of the health labour market framework.

Results 
Evidence from CAS highlights that conflict causes specific constraints in both the education sector and in the health labour market, and deepens any existing disconnect between those sectors. While the symptoms of these disconnects bear close resemblance to those in many other low- and middle-income countries, the unique set of societal drivers of conflict, governance dynamics and institutional constraints in CAS ‘multiply’ negative effects on the health workforce. Parallel and inadequate education and performance management systems, attacks on health facilities, and increased workload and stress, amongst other factors, affect HCW motivation, performance, distribution and attrition. Short-term, narrowly focused policy-making also undermines the long-term sustainability and resilience of the health workforce in CAS. 

Conclusion 
HRH policies, programmes and interventions must be aligned with the political and broader societal context, including the stage, severity and other dynamics of conflict. During conflict, it is important to try to monitor in- and outflow of HCWs and provide HCWs the support they need at local level or through remote measures. The post-conflict situation may present opportunities for improvement in HRH, but a clear understanding of political economy dynamics is required to better act on any such a window of opportunity.

Keywords